Last week got away from me and then I was on the island for the weekend so haven't had a chance to update the blog.
I spoke with the insurance company again on Friday and this time ended up
with someone who was actually helpful. I know it's hard to believe that a helpful person exists at an insurance company, but now we know at least one does!
I asked him to check about the ECHO. He didn't ask me for a code at all, just put me on hold and came back and said "yes you're covered at 100% so long as it's a network provider (which it is)". Gee that was easy, so I decided to try my luck. I decided I might as well ask about everything else regarding the biopsy since he seemed to be more educated than the daft cow I spoke to the day before. I listed off the six codes, he put me on hold again, and came back and said that it is all covered so long as it's a "medical necessity". I asked him if he could explain what exactly that was according to Oxford's definition and he was (shockingly) happy to. He said so long as your doctor feels it's necessary versus something like you want to have a blood test just for the heck of it. (why anyone would is beyond me, but you get the point).
I explained to him that the woman I spoke to the day before told me that I needed pre-authorisation for the lab codes I gave. He said that they do NOT require pre-authorisation, and so long as the doctor and facility are in network, it is covered. I checked with him about the lab in Seattle that my doctor said we would send my tissue to, as it is the one in the country that does this type of testing. To my huge relief he said that if it's the only lab that does that type and it's what the doctor needs, the facility would be viewed as "in network" and covered at that rate.
I am still weary that when all is done the insurance company will say it isn't covered, but I will just have to cross that bridge if/when I come to it. For now I'm going with the "it's all covered" idea!
